Becoming a PE Qualified Entity

Medicaid providers must be trained and certified by the KDHE Division of Health Care Finance (KDHE-DHCF) prior to making Presumptive Eligibility (PE) determinations. In order to become certified, the Medicaid provider must fulfill the following requirements:

  1. Complete and submit a Presumptive Eligibility Statement of Interest to KDHE-DHCF.
  2. A Memorandum of Understanding (MOU) contract must be drafted, agreed to and signed by the entity’s CEO or executive director and the KDHE Secretary. An implementation plan will be agreed to and followed.
  3. Each Entity must designate staff to complete the KanCare Presumptive Eligibility Training in order to conduct PE determinations at their facilities.

Qualified Entity Responsibilities

Presumptive Eligibility (PE) determinations are based on the self-attestation of the applicants. Entities are not allowed to require or request any documentation for verification during the PE application process.

PE specialists at the Qualified Entity are expected to do the following:

  • Review KMMS to ensure that applicants do not have active Medicaid coverage

  • Interview applicants to complete the PE application

  • Provide applicants with the eligibility results of their determination

  • Assist applicants in completing a KanCare application for ongoing coverage

  • Act as the facilitator for the consumer, receive and follow-up on correspondence requests made by the Clearinghouse

  • Track PE determinations completed at the entity

Forms & Documents for Providers

Presumptive Eligibility Overview PowerPoint (effective 04/16/2024) - PowerPoint presentation detailing the Presumptive Eligibility program.

Presumptive Eligibility Consumer Flyer - English, Spanish - A flyer explaining the Presumptive Eligibility program.

Statement of Interest- Document to be completed by facilities interested in becoming Qualified Entities.

Links

Presumptive Eligibility Main Page
PE Specialists Training Documents & Materials